title: Bilirubin influences the clinical presentation of pre-eclampsia.
abstract: OBJECTIVE
  Pre-eclampsia is a placental, inflammatory disease modified by maternal anti-oxidant status to give a syndrome. In its most severe forms pre-eclampsia is followed by maternal and neonatal mortality and morbidity. Bilirubin is a known antioxidant and as such is associated with a reduced risk of cardiovascular and respiratory disease. Hence we aimed to find an association between maternal bilirubin levels and the clinical severity of the disease.
  
  
  METHODS
  A retrospective observational study of 50,712 pregnancies, 925 of which had pre-eclampsia (1999-2010), to examine the association between bilirubin level and perinatal outcome.
  
  
  RESULTS
  In women with pre-eclampsia, those with bilirubin levels in the lowest quintile were more likely to require caesarean section (p=0.001, aOR 2.59 (1.52-5.72)). The lowest quintile of bilirubin levels is associated with an increased risk of poor maternal (p=0.002, aOR 3.52 (95%CI 1.6-7.7)) and infant/fetal (p=0.001, OR=3.05 (95%CI=1.63-5.72)) outcome.
  
  
  CONCLUSIONS
  Low levels of bilirubin were associated with poor maternal and infant outcomes in women diagnosed with pre-eclampsia. Bilirubin may act as an anti-oxidant in this condition and thus modify the disease.
authors.affiliation: Department of Reproductive Health, Warwick Medical School, University of Warwick, United Kingdom; Department of Obstetrics and Gynaecology, University Hospitals of Coventry and Warwickshire, United Kingdom. Electronic address: e.breslin@warwick.ac.uk.
authors.forename: Eamonn
authors.initials: E
authors.lastname: Breslin
authors.forename: Angelika
authors.initials: A
authors.lastname: Kaufmann
authors.forename: Siobhan
authors.initials: S
authors.lastname: Quenby
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000097:blood*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin
keywords: Bilirubin; Outcome; Pre-eclampsia; Prediction